08 Feb 01 - Medicine - Bypass ops 'lead to mental decline'

Heart bypass operations may lead to long term mental decline, suggests a study.

Thousands of men and women undergo the operations each year, to replace sections of coronary artery which have become hardened and clogged, leading to heart disease.

A period of short-term mental decline has been noticed in some patients, but this often appears to disappear again within a few months.

However, researchers at Duke University Medical Center in the US may have confirmed the suspicion that many patients suffer some sort of mental decline even years after the operation.

They looked at 261 heart surgery patients before and after the operation had taken place, measuring short-term memory, attention, concentration, language comprehension, and spatial orientation.

Indeed, more than half of the group were discharged from hospital after the surgery with some form of cognitive deficit.

This, as expected, improved, with only a quarter of the group having persistent problem six months later.

However, when the same group was re-checked some five years later, 42% had suffered a measurable decline in cognitive ability compared to their pre-operation state.

While it might be expected that some people lose some mental ability as they age, this group suffered a decline more than two times that found in a control group of nearly 6,000 patients of similar ages.

Cause unknown

Dr Mark Newman, who led the research, said: "Little is more devastating to patient and family than for the patient to have a successful operation that prolongs life, but diminishes the quality of that prolonged life.

"Our results confirm long-term persistence of cognitive dysfunction and the importance of preventing these deficits."

It is not known precisely what causes these problems, although suspicion falls on the heart-lung machine, which circulates oxygenated blood around the body once the heart has been stopped so the delicate operation can take place.

It is thought that tiny blood clots may form, travel to the brain and lodge in blood vessels, depriving very small areas of the brain of a blood supply.

In the future, minimally-invasive heart surgery, which does not require heart bypass, may become more common.

A spokesman for the British Heart Foundation said that while cognitive decline following heart bypass surgery was not unknown, most people recovered in the months following the operation.

She said that she hoped the study would not scare patients into refusing heart surgery, as the benefits outweighed the risks.

She said: "The introduction of beating-heart surgery should eliminate this problem."

08 Feb 01 - Medicine - Fast response promised on medicinal cannabis

The government will move quickly to legalise cannabis for medical uses such as relieving post-operative pain endured by multiple sclerosis sufferers if it passes current clinical trials, the Home Office minister, Charles Clarke, promised yesterday.

He renewed the promise when he appeared to give a progress report on the trials to the House of Lords science and technology committee, which has already urged the government to license the manufacture of cannabis products for medical purposes.

Mr Clarke said: "If the clinical trials into cannabis are successful, the government is clear that we are willing to amend the misuse of drugs act to allow prescribing.

The Home Office and the Department of Health were very clear that "once the outcome of the trials is clear, we will act expeditiously to ensure that any approved treatment can be brought into circulation".

Brian Davis, of the medicines control agency, told peers he could not say whether the new cannabis products would be available within the next two years.

Doctors have known that people often lose some of their mental sharpness immediately after a heart operation, but many seemed to recover fairly quickly. The new study, however, found that this recovery is short-lived.

The study looked at 261 patients who were on a heart-lung machine during bypass surgery. It found that five years after the operation, 40 percent showed a 20 percent drop in mental ability. That loss is similar to what a person normally goes through between the ages of 40 and 60.

Doctors do not know for sure why this mental loss happens, or even whether the operation causes it. For example, it might be that people whose arteries need to be replaced already have damaged blood vessels in their brains as well. The loss might also have something to do with being put on a heart-lung machine, which circulates blood through the patient's body during surgery.

An estimated 400,000 people a year are put on heart-lung machines for a bypass operation in the United States. The findings suggest that 160,000 of them risk losing some of their mental ability.

Dr. Mark Newman, who led the study published in Thursday's New England Journal of Medicine noted that many patients in the Duke University study might not have lived five years without the operation.

"Now it's a matter of fine-tuning" the operation "to improve the quality of life as well as the length of life," he said. Moreover, the people who lost mental ground in this study might have lost brain power faster anyway, said Dr. Irving Kron, chief of cardiac and thoracic surgery at the University of Virginia School of Medicine.

"It may be that the stress of the operation brings things out or pushes things along that were there to start with," Kron said.

Newman said other research appears to indicate that there are fewer problems with the brain after bypass operations done without the heart-lung machine.

Participants in the latest study took tests in memory, attention, concentration and manual dexterity five times: before the operation, when they left the hospital, and six weeks, six months and five years later.

Fifty-six percent did significantly worse when they were released from the hospital than when they were admitted. Nearly half of those people were back up to pre-operation levels when tested six months after the operation. But at the five-year mark, most were back down to the levels measured when they were leaving the hospital.

Older people and those with the least education were the most likely to have lower scores five years later. People who did not show any losses just after the operation were in equally good shape five years later.

08 Feb 01 - Medicine - Canadian relief as Ebola virus threat passes

Test results have soothed fears that the deadly Ebola virus could be making its first appearance in North America by way of a Congolese woman who fell ill shortly after arriving in Canada.

Health officials said that test results from a laboratory in Winnipeg, Manitoba, showed the woman is not suffering from the virus. But officials will continue to monitor at least 16 people - 14 hospital workers and two of the woman's friends - who had contact with her since she arrived in Canada on Saturday.

"Those are preliminary results. Viral isolation is still ongoing," Dr Mark Lobe, an expert in infectious diseases at Henderson Hospital in Hamilton, told a news conference Wednesday. Hospital workers looked on anxiously as he spoke.

The woman was hospitalized on Sunday night, and has thus far been diagnosed with malaria. Doctors are studying the possibility she has some sort of hemorrhagic fever. Tests are still underway in Winnipeg and at the US Centres for Disease Control and Prevention in Atlanta.

The woman remained in serious condition but was showing signs of improvement, doctors said.

The federal government had enacted a contingency plan for contagious viruses after discovering that possibility, but now believe the danger of her sickness spreading is minimal. The 32-year-old woman - she cannot be identified under privacy laws - has been quarantined since Monday.

A recent Ebola outbreak in Uganda killed 173 of the more than 400 people infected.

The woman arrived on Saturday in Toronto from Newark, New Jersey, on an Air Canada flight, airline spokeswoman Laura Cooke said. The flight had 39 passengers and five crew members. Her flight had arrived in New Jersey from Ethiopia, but it was not clear how she got to Ethiopia from Congo, The Toronto Star newspaper reported. She apparently came to Canada on a legitimate visitor's visa.

Canadian health authorities asked for a list of passengers on the flight, but also "advised us they do not consider this passenger to be contagious for casual contact," Cooke said.

Doctors said she has not shown signs of bleeding from the ears, eyes or mouth - conditions that would suggest the Ebola virus that can be lethal in more than 50 percent of cases.

But hospital workers said they were still worried and hadn't been given any official instructions on what to do.

"There's people now with their lives on hold, waiting to know what to do," said Debra Mattina, an X-ray technician and union representative. "We haven't been told whether we can kiss our husbands or send our kids to day care."

Ebola and the other hemorrhagic fevers are not transmitted through the air. Infection occurs through direct contact with the infected person's blood or bodily fluids such as saliva or semen, and only after they have exhibited symptoms such as fever and malaise.

That's why it was a relief for health officials to learn that the woman did not fall visibly ill until after arriving in Hamilton on Saturday night.

Lobe and others insisted there was little chance that the disease would spread and almost no possibility of a widescale outbreak.

08 Feb 01 - Medicine - Surgeon patents the secret of the orgasm

Dr Stuart Meloy was implanting some electrodes in a female patient's spine when he realised he might have hit on something. Abruptly the woman, who was under local anaesthetic, said excitedly: "You're going to have to teach my husband to do that!"

For while the routine operation was intended to relieve pain, Dr Meloy had stumbled on something far more pleasurable: the nerve cluster which, when stimulated electrically, induces (female) orgasm.

Now he has patented an implant device, which could be operated by a simple button to give a very pleasurable lift to any woman's day - and especially to the surprisingly large number who psychiatrists say suffer from "orgasmic dysfunction". Woody Allen's 'orgasmatron" from the film Sleeper, has finally arrived.

The as-yet unnamed device is due to start clinical trials later this year. And Dr Meloy, a surgeon at Piedmont Anesthesia and Pain Consultants in Winston-Salem, North Carolina, is already looking ahead to a device which could do the same for men. Dr Meloy, who revealed his discovery in New Scientist magazine, believes the device, would have to be programmed to limit its use. "But whether that's once a day, four times a week - who am I to say?"

04 Feb 01 - Medicine - Bone disease breakthrough

The first once-a-week pill to counter the bone-thinning disease osteoporosis became available in Britain last week.

The Department of Health estimates that more than half of older women are unaware of the signs of the malady, which means that they may be at risk. Despite widespread publicity about the importance of healthy eating and exercise for the over-50s, two thirds think there is little that can be done.

Researchers who developed the drug to help strengthen weak bones believe the new once-a-week formula will help millions of women later in life. Until now the pill, which contains Fosamax, also known as alendronate, a well-tried drug which can significantly strengthen bones, had been refused by many women because it was so difficult to take.

Tablets had to be taken first thing every morning and the patient had to avoid food and stay upright for half an hour afterwards so that the chemical could be properly absorbed. Now scientists at the company which manufactures it, Merck Sharp and Dohme, have established that effective levels of the drug can get into the bone even if patients only endure this ordeal on a weekly basis.

Osteoporosis afflicts one in three women in Britain and one in 12 men. The cost to the NHS of dealing with its effects is so large - £1.7 billion a year - that the Department of Health has declared it a public health priority.

Although it appears inert, bone is a living tissue which is constantly being renewed by cells which break bone down and build it up again. In older people, however, and especially in women who lack the hormone oestrogen after the menopause, bone may be broken down faster than it can be replaced, causing the bone structure to weaken.

The consequences can be devastating. Nearly 70,000 people fracture a hip in falls in the United Kingdom every year. Eighty per cent are women over 50 and 12,000 of them will have died within a year of the accident. Osteoporosis is also responsible for 50,000 fractures of the wrist and 40,000 spine fractures dealt with by hospitals annually.

Fosamax is one of a class of non-hormone drugs known as bisphosphonates which work by switching off the cells that break down bone. Hormone Replacement Therapy (HRT), which replaces missing oestrogen, is one of the main alternatives for women at risk of osteoporosis. Doctors recommend that HRT be taken for only a maximum of 10 years, however, and many women have to stop taking it while still in their 60s.

The National Osteoporosis Society said yesterday: "This is a new and convenient way of taking a treatment and that is going to be good news for women." Dr Mike Stone of the Bone Research Unit at Llandough Hospital in Penarth said that studies on Fosamax had shown that the drug could reduce the risk of a hip fracture by 63 per cent after 18 months of taking it.

The once-a-week pill was an "important advance", he added. "It offers patients a much greater degree of convenience. This is particularly important in a long-term condition such as osteoporosis that often shows no symptoms." Tom Palferman, clinical director of the Somerset Osteoporosis Service, said: "We hope it will improve compliance and results in the long run. Anything that reduces the incidence of hip fractures is going to be very very important. More women die from this than from breast cancer."

04 Feb 01 - Medicine - Transplants at risk as organ panic grows

Alan Milburn, the Secretary of State for Health, has ordered an emergency summit to help revive public confidence in organ donation after the Alder Hey scandal.

The eminent transplant surgeon Sir Magdi Yacoub raised alarm when he warned that public fears over organ donation, triggered by the body parts disgrace, threatened to put lives at risk. Although the Department of Health stresses there is no indication that interest in organ donation is in grave decline, a spokesman said: "There could be a crisis."

The summit, expected to be held in London during "the next few weeks", will bring together medical professionals, including Professor Yacoub, as well as scientists, charity groups, business leaders, trade union bosses and transplant organisations.

Mr Milburn hopes the summit participants will devise a public awareness campaign to allay fears about organ donation as well as encourage people to carry donor cards.

One idea, supported by Mr Milburn, is for organ donor cards to be included in employees' pay packets, with a leaflet explaining the changes the Government has made with organ donation. Mr Milburn said: "Our aim is to maintain confidence in the programme and [make] sure people feel reassured they'll be treated with dignity and respect." He said the overriding principle was one of consent, with nothing happening without consultation.

The Government is determined the scandal surrounding Alder Hey Children's Hospital in Liverpool and the Bristol Royal Infirmary - following the discovery of stored foetuses, and 104,300 organs and other body parts after children's bodies were stripped without their parents' consent - will not undermine the country's transplant programme. But already UK Transplant, which links donors and organ recipients, has said that it had few enquiries last week.

There are, at present, eight million people in Britain who have pledged to be organ donors. The DoH spokesman said education about the issue was important. "There has been a lot of confusion about retention of organs [for research] and organ donation [for transplants]. We want to make sure people understand the difference."

04 Feb 01 - Medicine - Doctors call for action to halt fall in donors

Doctors' leaders are to urge ministers to set up a national organ donor service and a central register at an emergency summit later this month to address a serious slump in donations.

The proposals from the British Medical Association, donor groups and the medical colleges follow an appeal from Alan Milburn, the Secretary of State for Health, for a national campaign to restore public confidence damaged by the Alder Hey scandal.

Mr Milburn has also indicated that he supports proposals to ask employers to include donor cards in wage packets amid growing evidence that the body parts scandal at the Liverpool hospital has aggravated a national shortage in available donors.

He is expected to unveil plans for a publicity campaign, including leaflets explaining tighter controls on patient consent laws, to persuade the public of the need for donations for organ transplants and crucial medical research.

Although Department of Health officials insisted last night there was no crisis at present, the current problems could worsen. Mr Milburn said the eight million who already carried donor cards "need to have full confidence that they will be treated with dignity and respect at all times". He added: "I want to step up our drive to get more donors so that vital medical advances are not halted and people whose lives could so easily be saved with a transplant are not left to die unnecessarily."

The latest figures show a steadily widening gap between transplants and waiting lists. Throughout the 1990s, the number of people waiting for transplants leapt by 55 per cent, to nearly 4,600 in 1999, but in the same period the level of transplants dropped by 5 per cent to little more than 1,500. Waiting lists are increasing by approximately 3 per cent a year.

Advisers to the Health Secretary indicated last night that the Government would seriously consider the BMA's proposals, particularly setting up a central register. The present donor system is locally based, and relies heavily on a potential donor carrying their card at all times, or their relatives being aware they have signed up. A central register would allow the National Health Service to establish if a dying or dead patient has given consent.

The BMA, which coordinates the Transplant Partnership campaign with groups such as the British Kidney Patient Association, British Organ Donor Society and the Royal Colleges of Physicians and of Surgeons, is also expected to suggest that GPs are asked to persuade their patients to sign up as donors.

Dr Michael Wilks, chairman of the BMA's medical ethics committee, said yesterday the decline in donations was "extremely worrying". He added: "It is absolutely essential that the anger and concern over past practice in relation to organ retention for research does not have a lasting and damaging impact."

The emergency summit, expected to be held within 10 to 14 days, will bring together transplant experts including Sir Magdi Yacoub, Britain's most eminent transplant surgeon.

04 Feb 01 - Medicine - Britains go to Germany for Treatment

Britons fed up with long hospital waiting lists are paying to be given instant treatment at German hospitals.

The most common operations being requested include those for cataracts, knee replacements, hip replacements and heart bypasses.

German authorities have drawn up plans to tempt the NHS into a deal to pay some of the bills, which until now have been privately settled.

Scores of fed up NHS patients have already taken up the German offer.

The German Embassy in London has even had a brochure made to advise people on having treatment with Germedic - with flights and care by English-speaking medical staff being part of the package.

Surgery for cataracts in Germany costs £975, a replacement knee operation just under £7,000, hip replacement surgery around £5,500 and a heart bypass is priced at £7,000.

Mr Georg Westphal who manages the committee promoting German medicine abroad said: "There has been a good response from British people operated on by German doctors. We have performed knee operations on them and I know of one woman who even arranged to come over to give birth here in Germany."

The German embassy in London says it has been inundated with requests for treatment.

"We give them the phone number in Bonn and let them sort it out for themselves," the attaché at the embassy said.

An NHS spokesman says it does not think the scheme will be a huge success because "people do not want to go abroad for treatment".

01 Feb 01 - Medicine - Molecule clue to fighting lung cancer

Scientists have made a breakthrough in the fight against small cell lung cancer.

They say it could see the development of new drugs to combat the disease within three to five years.

Small cell lung cancer is the most serious form of lung cancer.

According to the Cancer Research Campaign which funded the scientists at Glasgow University, it accounts for a quarter of the 40,000 new cases in the UK.

Led by Dr Nicol Keith, the team discovered why the small cell lung cancer cells divide so often, spreading out of control and how they become "immortal".

Their research has identified a molecule called telomerase, which is known to encourage cells to divide, as playing a crucial role in the development of the prolific small cell lung cancers.

They found that in 98% of these cancers the telomerase gene (hTERC) was "switched on" - and so accelerating the growth of the cancer cell - while in less aggressive forms of lung cancer only 59% had a switched-on telomerase gene.

Knowing whether tumours have a switched-on gene and how many telomerase molecules they possess is vital if drugs are to be designed to block the molecule's effects.

Dr Keith and his team are now looking at exactly how cancer cells switch on the telomerase gene, and trying to discover what makes small cell lung cancer cells so likely to have them switched on enabling them to divide.

They believe that if they can stop cells from gaining large amounts of telomerase, they might be able to prevent cancer from developing.

01 Feb 01 - Medicine - Scientists find key to spread of breast cancer

A Key to understanding how breast cancer spreads, often fatally, to other parts of the body has been discovered by scientists.

One mechanism by which cancer cells spread - metastasise - to the lymph nodes and lungs has been found by Massachusetts General Hospital researchers in Boston.

The finding will help doctors to assess the risk that a tumour will spread. By using drugs to block this pathway, it may be possible to hinder the deadly proliferation of cancer cells from a primary tumour.

"We have identified a mechanism of breast cancer metastasis, but I wouldn't say it's the mechanism because there may be several others," said Dr Michael Detmar, one of the team who reports the find in Nature Medicine. "But this is certainly a major molecular mechanism."

Although cancer cells are believed to enter the lymph nodes through the lymphatic system - a multipurpose tangle of vessels - little is known about how this is done.

Now Dr Detmar, Dr Mihaela Skobe and colleagues report that tumour cells spread through a system of lymphatic vessels cultivated by the tumour. "The role of the lymphatic vessels in the tumour has been controversial, disputed or negated," said Dr Detmar. "In fact, the dogma was that tumours do not have functioning lymphatic vessels."

However, using a new imaging method, the team observed networks of lymphatic vessels deep inside breast tumours grown in mice and found that the more lymphatic vessels, the more cancer that had spread to the lymph nodes and lungs.

They found that a molecule called VEGF-C caused the growth of lymph vessels within the tumours and metastasis to the lymph nodes and lungs. A better understanding of the action of VEGF-C could lead to new approaches to treating and preventing cancer metastasis, said Dr Detmar.

In another study Dr Steven Stacker and colleagues at the Ludwig Institute for Cancer Research, Australia, found that a molecule called VEGF-D caused the formation of lymph vessels within tumours and spread of cancerous cells to lymph nodes, an effect that was blocked with an antibody to VEGF-D.

Another way to block the formation of lymph vessels has been found by Dr Kari Alitalo and colleagues of the University of Helsinki. A soluble form of a substance called VEGFR-3 can block both VEGF-C and VEGF-D.

01 Feb 01 - Medicine - Scientists find key to spread of cancer cells

A mechanism by which breast cancer spreads to other parts of the body has been identified, raising hope of developing new methods of treating the disease.

Breast tumours grow their own lymphatic vessels, allowing cancerous cells to break out and to invade other tissues using the pathways of the body's immune system, researchers in America have discovered. The unexpected findings may explain why breast cancer is particularly likely to spread around the body, causing secondary tumours in the lungs, liver and brain that are often fatal.

The research also suggests an encouraging new strategy for treating the disease, which kills 13,500 women in Britain every year. Scientists believe that it should be possible to develop drugs that stop breast tumours from forming new lymph vessels, blocking the "escape tunnels" through which they send deadly material into other parts of the body.

Other cancers may prove vulnerable to a similar approach, if it can be shown that they also create their own lymph vessels.

The process of metastasis, by which cancer cells travel around the body through the lymphatic system, a network of vessels and nodes that is important to immune functions, has been partially understood for some time. The new study, at Massachusetts General Hospital in Boston, is the first to show that any sort of tumour creates its own lymphatic tissue to tap into the system. Previous work has found no evidence of lymph vessels in tumours and many scientists have assumed that the pressure inside a tumour would crush any of the delicate structures if they did begin to grow.

The researchers, who publish their results today in the journal Nature Medicine, developed a new imaging method to allow them to see lymphatic tissue inside human breast tumours that were grown inside mice. They found not only that such vessels were created, but also that they then plugged into the rest of the lymphatic system and carried cancerous cells away from the tumour.

The number of vessels in a tumour was closely related to the number of cancer cells that appeared in the lungs and lymph nodes of the mice - suggesting that a tumour's success at creating the vessels was directly connected to its ability to spread.

Michael Detmar, who led the study, said: "We have identified a mechanism of breast cancer metastasis. I wouldn't say it's the mechanism because there may be several others, but this is certainly a major molecular mechanism of how breast cancer metastises to the lymph nodes."

The development, he said, could lead to therapeutic benefits for patients. "In the future we may be able to determine the amount of lymphatic vessels in a breast cancer specimen obtained from a patient, and it may allow us to predict whether a tumor has a high risk of metastasis or a low risk depending on the density of lymph vessels in the tissue."

Doctors would then be able to tailor a patient's treament according to whether a cancer was deemed likely to spread, Dr Detmar said. The research could eventually be developed to find ways of stopping tumours from producing lymph vessels.

30 Jan 01 - Medicine - Contraceptive gel could be used to stop spread of Aids

Women could soon be able to buy an "invisible condom" that will act both as a contraceptive and stop sexually-transmitted diseases, including HIV, which causes Aids.

Two teams of American scientists are developing gel-based products for women which both kill sperm and also HIV and other microbe-borne diseases. One of the teams has recently completed tests in cats, which showed that the gel was effective against the feline form of HIV, called feline immunodeficiency virus.

If either team succeeds in getting the gel through human clinical trials, the market could be enormous. A survey last February found that in the United States roughly 21 million sexually active women would be interested in using such a gel.

Though most new cases of HIV occur in developing countries, there has also been a rise in cases in Britain and America. While condoms are nearly 100 per cent effective in blocking both HIV and sperm, women often find it difficult to insist that men use them.

Dr Alan Stone, who chairs the international working group on microbicides, said there has been a "positive trend" among pharmaceutical companies in thinking abo

30 Jan 01 - Medicine - Scanner shows womb with a 3D view

A scanner that allows expectant parents to see the face of their unborn child has been developed by scientists.

The new device, which is made by the electronics company Siemens, will also help doctors to diagnose a range of foetal abnormalities, including tumours, spina bifida and cleft palates, and administer more effective prenatal treatment. The three-dimensional images may also promote parent- foetal bonding, which doctors consider to be an important factor in subsequent parent-child relationships.

Rose de Bruyn, a radiologist at Great Ormond Street Hospital for Children in London, said the uterine scanner would offer parents a chance to see their unborn children in detail. "With faster computing, improved image processing and visualisation tools, parents will now be able to see detail that was previously difficult to appreciate in two dimensions," she said. "Incredibly detailed images of the unborn foetus can now be readily available at the patient's bedside using these imaging techniques."

Doctors and sonographers will be able to view images almost instantly, quickly access areas of interest or increase the number of views. Richard Kirby, ultrasound manager for Siemens, said: "Siemens is all about developing cutting edge technology that changes lives. The 3D scanner will touch the lives of parents and give the medical profession access to a diagnostic tool which will significantly improve their ability to detect and treat abnormalities before birth."

29 Jan 01 - Medicine - FDA Approves Drug for Deadly Fungus

WASHINGTON (AP) - The government approved a new drug called Cancidas on Monday for immune-weakened patients suffering an often fatal fungal infection.

The intravenous drug is the first in a new family of anti-fungal medicines called echinocandins that work by attacking fungal cell walls.

The Food and Drug Administration approved Cancidas to treat infections known as invasive aspergillosis in seriously ill patients for whom other therapies have failed.

The Aspergillus fungus is very common and doesn't harm most healthy people. But it can kill people with weak immune systems, such as cancer and AIDS patients and organ transplant recipients.

Manufacturer Merck & Co. gave Cancidas, known chemically as caspofungin acetate, to 63 patients. All had failed or couldn't tolerate other treatments, so the FDA didn't demand that Cancidas be compared with an alternate drug or dummy pill.

Half of the 52 patients who received more than seven days of IV Cancidas significantly improved or saw the infection resolve.

The most common side effects were fever, infused vein complications, nausea, flushing and vomiting.

Cancidas is not a first-line treatment for newly diagnosed patients, nor should it be used together with cyclosporin, a common drug among organ recipients, FDA warned.

Merck said Cancidas will be available in 10 days, and cost $288 per daily IV infusion.

Women who continue to breast feed long after their children have started on solid foods may be protecting themselves against breast cancer, a study suggests.

Researchers have found that mothers who breast feed past a child's second birthday are half as likely to develop the disease as those who stop at 12 months. The study is the latest to show benefits from extended breast feeding.

Dr Tongzhang Zheng, of Yale School of Medicine, New Haven, Connecticut, chose to study China for its long-term traditional breast feeding. "In Chinese society, it is socially acceptable to breast feed for a long time and it is considered good for the child."

He investigated the relationship between breast cancer risk and lactation between 1997 and 1999 in Shandong Province hospitals. He took into account the number breast fed, duration of breast feeding per child, how many years women were breast feeding and the age at which they began.

Dr Zheng found 404 women with breast cancer and compared their lifestyles with a sample of women without the disease. Mothers who breast fed each child for more than two years were half as likely to develop breast cancer compared to women who breast fed for less than 12 months.

Long-term breast feeding also appeared to reduce the risk of breast cancer among post-menopausal women. The age of first breast feeding and the total number of children breast fed did not seem to make any difference.

Dr Zheng said: "This is a crucial time to do a study in China because of the country's one child policy. If we do not take the opportunity to do this study now, the opportunity will be lost."

Studies in Western countries found that breast feeding was not significant in reducing breast cancer risk. Some have suggested that the effect is limited to pre-menopausal women, but that could be explained by few women in the West breast feeding for more than a year.

Dr Zheng said: "We probably will never be able to resolve this issue in cultures where they do not have long-term breast feeding history. Our findings in China are clear. The longer duration of lactation - whether it is based on breast feeding of a first child or breast feeding over a lifetime - leads to a significantly reduced risk of breast cancer."

His research, published in the American Journal of Epidemiology, followed three studies conducted in the early Eighties in Shanghai, Beijing and Tianjin. Then, scientists found a 50 per cent reduction in breast cancer among women who breast fed for more than 109 months in total compared to women who never breast fed.

28 Jan 01 - Medicine - Ulster develops mobile heart test

Scientists in Northern Ireland are developing a mobile phone that will double up as a heart monitor. The handset, designed by researchers at the University of Ulster, will allow doctors to assess patients' health remotely.

It is expected to reduce hospital waiting lists by allowing some patients to be sent home shortly after surgery.

Patients will attach electrodes to their chest and plug a special device into the phone socket currently used for hands-free sets. The sensors will then monitor their heart rate and body temperature, and store the information in the attachment. A computer will then call the phone at set intervals, transmitting its data to a receiver at the clinic or hospital. If problems are identified, doctors will contact their patients.

The team is also developing a remote diagnostic system. This will allow surgeons to instruct ambulance staff on emergency treatment to heart-attack victims using information transmitted from the sensors.

Northern Ireland has the highest rate of coronary deaths in western Europe. More than 4,000 people died from heart disease there last year, a death rate 20% higher than in the rest of Britain. The republic also has a high incidence of heart disease.

Cardiac surgery in Northern Ireland is carried out at the Royal Victoria hospital in west Belfast, but operations are restricted because there are only 10 intensive care beds for adults and three for children.

Andrew Dougal, chief executive of the Northern Ireland Chest, Heart and Stroke Association, said: "Being able to diagnose the condition of a heart-attack victim remotely would be an asset, because the first few minutes of treatment are absolutely vital. The chances of survival would be increased if a cardiac surgeon were able to supervise the work of paramedics at the scene.

"The ability to monitor a patient's health from a distance would greatly reduce the anxiety for people waiting for surgery, as well as providing peace of mind afterwards. It would also tackle the problem of bed shortages, the main reason why 230 people in Northern Ireland had cardiac surgery postponed last year."

Dougal warned that the waiting lists for heart surgery were set to grow because of delays in replacing the senior cardiac surgeon in the province. Hugh O'Kane, the senior consultant surgeon at the Royal, retired in November, but his replacement is not expected to take up his post for another three months.

Dr Noel Evans,who has been researching telemedicine for 20 years, said the system would have built-in safeguards. The cable carrying data from sensors would also fit land lines, and short-range radio links would boost signals where cellular reception was poor.

"This will be of particular benefit to people who have undergone surgery and are well enough to be released but are kept in hospital because their condition needs monitoring. It will also provide reassurance for people on waiting lists who are considered to be at risk."

Researchers plan to improve the system to enable it to alert doctors to changes in patients' heart rate or temperature.

Royal Victoria hospital's cardiology centre, which helped to develop the world's first cardiac ambulance in 1967, is collaborating on the project and clinical trials are under way. The research is being funded by charities, private donations, Northern Ireland's Engineering and Physical Research Council and Orange, the telecoms company.

The university has been at the forefront of telemedicine research for a number of years. It developed body-surface mapping, which uses electrodes to produce a colour image identifying the cause of chest pain in the early stages of a heart attack. Meridian Technologies, an American company, manufactures the equipment in Belfast and sells it to hospitals around the world.

Professor John Anderson, head of the school of electrical and mechanical engineering at the university, says bodymapping data and other diagnostic information will be relayed by mobile phones. "It is the sensor technology that will make the decisions and that is what we are developing," he said. "The next move will be to integrate all the sensory technology into phones.

"That means the phone could transmit data on potassium and chlorine levels in addition to heart rate, blood pressure and temperature. That will enable doctors to identify problems and begin introducing treatment at a much earlier stage."

The development will be embraced by the medical profession if it reduces waiting lists. Dr Brian Patterson, chairman of the GPs' committee of the British Medical Association in Northern Ireland, said the health service was in crisis.

"Politicians keep telling us that the health service is improving rapidly, but that does not match what I am seeing clinically. We are heading for a nightmare scenario unless something is done quickly," he said.

How mobiles can provide a health check

The handsets, developed by the University of Ulster, come with a special attachment to store the information

1 Patient will have electrodes attached to chest to monitor heart rate, along with heat sensors inside a wound or under the armpit

2 The electrodes would be connected to a mobile phone. This could be worn on a belt, the connections being concealed by clothes

3 A computer in a hospital is programmed to call the phone at regular intevals to receive data

4 If evidence of problems exists, a doctor will be alerted and the patient will be called on the phone asking them to report for treament or take medication

28 Jan 01 - Medicine - Man's germs wiped out mammoths

They were some of the most remarkable creatures to roam the Earth. For aeons, mammoths, mastodons, giant armadillos, dog-sized rodents, sloths as big as giraffes, and sabre-toothed tigers ruled the plains and forests of North and South America.

Then, 11,000 years ago, they vanished from the face of the Earth, a disappearance that still provokes fierce arguments among scientists.

But now a leading palaeontologist believes he has found the cause of the extinctions: these great animals died because they caught coughs and colds from human beings. And the implications for our planet could be catastrophic. 'Upward of 130 species disappeared in a time period of maybe half a millennium or less,' said Dr Ross MacPhee, of the American Museum of Natural History in New York. 'Disease is the only thing that I know of that could do that.'

The disappearance of the great mammals was originally described by Charles Darwin. 'It is impossible to reflect on the state of the American continent without astonishment,' he noted. 'Formerly, it must have swarmed with great monsters; now we find mere pygmies.'

For the next 100 years, scientists struggled to make sense of the disappearance of the mammoth, mastodon and giant sloth. Then they began to date the bones of these creatures and found they had all been wiped out within a few hundred years of each other.
Crucially, it was at this time that humans first travelled to America, from Asia across a land bridge that joined Siberia and Alaska, leaving signs of their progress in the form of carved stone arrowheads and spearpoints. These early Americans were clearly great hunters, and were quickly fingered as the eradicators of America's mammoths and mastodons.

'Large animals disappeared not because they lost their food supply but because they became one,' says Dr Paul Martin of Arizona University, protagonist of the 'overkill hypothesis'.

But the theory suffers from a major drawback, scientists have realised: there is little evidence to support it. Despite a plethora of fossil remains, only six mammoth bones have been found with spearpoints in them. As for the other 130 species wiped out, not one has been found near an arrow or with a sign of having been butchered.

'People were hunting but not on a scale that could have made any difference to the survival of the species,' says MacPhee. 'You'd have to be killing things all the time and you'd have to be doing it for some purpose. It's unimaginable that the people concerned would be interested merely in killing, especially large, dangerous animals like mammoths.'

Instead MacPhee believes America's great creatures were victims, not of human aggression, but of diseases introduced by us, or possibly by animals such as dogs or rats travelling with us. 'You can imagine a situation, especially for herding animals, where the pathogen could be passed through a population in days,' he argues. 'They would be falling all over the place, without any clear threat at hand.'

MacPhee points to recent epidemics introduced by humans that have wiped out species of toads and frogs in North America, and populations of birds such as the Hawaiian honeycreeper. Similarly, African wild dogs in the Serengeti have been killed off by canine distemper transferred from domestic dogs, while rinderpest - introduced into Africa 100 years ago - eradicated millions of wildebeest, hartebeest and others.

Such outbreaks are trivial compared with those that could have been triggered by humans leaving Africa and Asia and entering America for the first time. 'All kinds of organisms could have been brought to places where humans had never been previously resident,' says MacPhee, whose ideas will be outlined in next month's Scientific American. In a bid to prove this idea, MacPhee is probing tissue of mammoths found in permafrost. He aims to extract the DNA of bacteria, viruses or protozoa, and provide crucial evidence for his theory.

If he succeeds, he believes he will have demonstrated that our planet and all its species, including humans, will always be highly vulnerable to disease. Just as we infected and killed off the mammoth, so the animal world has given us ailments ranging from flu, which originated in poultry, to Aids, which we got from apes. One disease could mutate with effects as final as the one that killed off the giant sloth. Consider the flu epidemic of 1918, he says. 'This was the worst killer plague in recent times - it killed between 20 and 40 million people in a year and a half. Yet this novel flu evidently gained its lethality through a couple of substitutions in a couple of its genes.

'These things are going on in the disease pool we all share in all the time. I suggest we should be very, very frightened by these facts.'

Anita Ellis became part of Britain's most worrying medical puzzle one night in May last year, when she woke with agonising stomach pains. Her doctor gave her a painkiller. Over the next few days she had a series of tests and was diagnosed as having adult-onset diabetes. The doctors were surprised because Anita was only 15.

But she is not alone. The Observer has learnt that doctors in other parts of the country have seen nine-year-olds with the same type of diabetes, which is normally seen in people 30 years older.

With more than a million under-16s in the UK classed as overweight or obese - double the number in the mid-Eighties - doctors are becoming convinced a junk food and couch-potato lifestyle is speeding their bodies into a disease of middle age.

In obese diabetics, the cells producing insulin to control blood sugar wear-out, fighting a losing battle to maintain the body's equilibrium. Undiagnosed diabetes can lead to infertility and eye damage, or even fatal kidney or heart disease.

Anita has come to accept that she has a condition that is a symptom of cellular middle-aged burn-out. 'At first I didn't want to tell my friends because they would think I was strange. They were very understanding when it was explained what they would have to do if I had a funny turn. And they understood that I would have to do a blood sugar test four times a day, take tablets and change what I eat,' said Anita, who lives in Romsey, Hampshire.

Since her diagnosis Anita, now 16, has lost over a stone in weight and is taking tablets and regular exercise, which it is hoped will stave off early health problems. 'The doctors were really surprised and at first I was really scared when it was diagnosed.

'I used to love my chips and crisps, but now I only have chips once a week and have cut out crisps and chocolate altogether and take fruit to school. And I do feel a lot healthier and happier since I was diagnosed.'

Doctors Sarah Ehtisham, Nick Shaw and Tim Barrett uncovered the first-ever British cases of type 2 diabetes in eight obese children in Leicester and the West Midlands. The youngest was nine when diagnosed. She had to have eye surgery after developing a cataract - a classic complication of diabetes.

'These are the first cases of type 2 diabetes in children in the UK, although this has become a well-recognised problem in other parts of the world, notably the US,' said Barrett. 'The onset of this form of diabetes at a young age means there will be more time for complications to develop over the lifetime of the individual.'

The World Health Organisation and the charity Diabetes UK estimate that there are a million 'hidden' diabetics in the UK. Doctors fear many are children who will not be diagnosed until serious damage is done. They want to raise awareness among doctors because medical training doesn't recognise type 2 diabetes in children. In Japan, type 2 is now the most common form in children. In the US, where nearly half of child diabetics are type 2, there is routine screening.

27 Jan 01 - Medicine - Dentist cures severe case of tusk ache

An English dentist was called upon to operate yesterday on an Indian elephant that had lost part of its right tusk at a German zoo.

Dr Peter Kertesz was told that the eight-year-old patient, Chamundi, had been in agony for several months after fighting with other elephants at the zoo in Münster, northwest Germany. His remaining 20in stump was in danger of infection.

Dr Kertesz, who spends most of his time at a London dental surgery, was asked to help because he is the founder of an organisation called Zoodent and has operated on many animals.

"An elephant with toothache is not a very happy creature," a Münster Zoo spokesman said. "But he is back on his feet after the operation and feeling a little groggy but otherwise fine."

Dr Kertesz and his team of five, including Dr John Lewis, an anaesthetist, made the elephant unconscious with a drug called etorphine, which has 10,000 times the tranquillising power of morphine.

Once on his side, Chamundi was fed gas as Dr Kertesz set to work with an industrial drill in a four-hour operation.

"We tried rotating the tusk and pulling it, but it wasn´t coming out," he said. "In the end we drilled down through the tusk - it is just like a tooth, only a long curved cylinder - and began hollowing it out at its base until I could cut it in four sections and extract each one."

Zoo officials said that Chamundi might later be fitted with a false tusk.

27 Jan 01 - Medicine - Diabetics 'freed from tyranny of daily jabs'

A potential "cure" for thousands of people suffering from the most serious form of diabetes is to be tested in Britain. The pioneering technique, which ends the daily routine of life-saving insulin injections, was developed by a British-born surgeon in Canada.

Cell clusters that produce insulin are transplanted into the livers of diabetics so they can create the hormone that regulates blood glucose levels themselves. Thirteen of the 15 patients who have had the ground-breaking cell transplants in Canada have been "effectively cured" and no longer require daily injections.

The charity Diabetes UK is funding seven centres at British hospitals where the technique developed by James Shapiro will be tested. Britain has about 1.4 million known sufferers of diabetes, a condition in which the body cannot convert blood glucose into energy because insulin is not produced or does not work properly.

Half a million diabetics rely on daily injections of insulin to maintain their glucose levels, and 50,000 of these have the most serious Type 1 form of the disease.

In a £300,000 pilot this summer, 10 British patients will receive cell transplants and, if successful, the project could be expanded to treat up to 400sufferers each year. These patients would have to spend the rest of their lives on a cocktail of drugs to prevent the bodyrejecting the pancreatic cell clusters.

Because of the potential and as yet unknown dangers of long-term immuno-suppression drugs, the treatment is considered suitable only for people with Type 1 diabetes.

At the launch of the project yesterday, Moira Murphy, director of research at Diabetes UK, said: "It is early days yet, but this may well lead to a cure for diabetes. If this research proves successful, it could revolutionise the lives of people who currently need to take daily insulin injections just to stay alive."

Scientists warn that several years will be needed to see whether the transplants have worked and the technique is a definite cure. But one of the Canadian patients, who has had more than 40,000 insulininjections since he was diagnosed 40 years ago, said his life had been transformed.

Bob Tesky, 54, of Alberta, said: "In the past year I have seen a miracle happen in my life. Even in my wildest dreams, I never expected there would be a day when I would no longer need to go through the routine of insulin, blood tests, all of the anxiety that accompanies this disease. I always expected that sooner or later things would get worse, I never expected things could be so dramatically better.

"I have not taken an insulin injection since last August. Amazingly, all of the key tests show I am functioning as a normal non-diabetic."

The British centres are at King's College Hospital and the Royal Free Hospital in London, Oxford Transplant Centre and Nuffield Department of Surgery, Southmead Hospital in Bristol, Worcestershire's Acute Hospital NHS Trust, Addenbrooke's Hospital, Cambridge and the University Hospitals of Leicester.

27 Jan 01 - Medicine - Diabetes 'cure' to undergo test

The pioneering technique involves transplanting cells into the livers of diabetes victims and puts an end to the need for daily insulin injections.

The transplantation technique has been developed in Canada by British-born surgeon James Shapiro and has so far led to 13 patients being effectively "cured".

About 1.4 million people in the UK are diagnosed with diabetes and an estimated million more have the condition but are not aware of it.

Diabetes stops the body converting the glucose in its blood into energy because the hormone insulin is either not produced or does not work properly.

Half a million diabetes sufferers have to give themselves daily injections of insulin to maintain their glucose levels, and 50,000 of these have the most serious Type 1 form of the disease.

In Type 1 diabetes, the islet cells in the pancreas which produce insulin are for some reason destroyed by the body's own immune system.

Mr Shapiro has developed a technique where islet cells are taken from a donor and injected into the diabetes sufferer's liver.

The process can be completed in half a day and is done under local anaesthetic. After two injections, the cells kick-start the body's insulin production, although patients have to take anti-rejection drugs for the rest of their lives.

So far 13 of the 15 patients who have had islet cell transplantation in Canada no longer have any need for daily insulin injections but scientists warn it will take several years to see whether the transplants have worked and the technique is a "cure".

26 Jan 01 - Medicine - Alternative to stem cell therapy developed

British scientists have developed a way of using immortal human cells to repair bone and renew the brain. The method offers an alternative to stem cell therapy which they believe will work better and will raise no ethical issues.

Normal cells divide only a limited number of times before they die, but the new technology, developed by Dr Bradley Stringer of Sheffield University and Dr George Foster of Cardiff University, cancels out this process, enabling an infinite number of cells to be generated from the original source.

Clinical trials of the new bone-repair material could begin within 12 to 18 months at Sheffield University, with a possible treatment for Parkinson's disease to follow a year or two later.

The cells are not stem cells - research into which was approved by the House of Lords after a debate on Monday - but specialised cells that can be multiplied indefinitely in culture dishes.

26 Jan 01 - Medicine - Thalidomide is used in cancer treatment

Thalidomide, the most feared drug of the last century, is to be tested on 30 lung cancer 30 patients in London and Leeds. The once-notorious drug was banned in 1962 after pregnant women who took it to quell morning sickness gave birth to an estimated 12,000 deformed babies worldwide. But thalidomide is making a gradual comeback.

Scientists have discovered properties unrecognised 40 years ago, and are harnessing them to treat a range of diseases. Its dangerous teratogenic effects, causing birth defects, apply only if it is taken by women who are pregnant.

Thalidomide has been shown to be a highly effective treatment for a form of bone cancer called multiple myeloma and has been used to treat HIV, rheumatoid arthritis and Bechet's syndrome, which causes ulceration of the eyes, mouth and nose. It is also licensed in the US for the treatment of severe ulceration and leprosy. In Britain, it has been used to treat brain cancer, kidney cancer and Kaposi's sarcoma, a cancer involving the blood vessels of the skin common in patients with HIV.

The Cancer Research Campaign is backing the latest trial of the drug in patients with small-cell lung cancer, the most deadly form of the disease, that kills around 9,000 people a year. Professor Gordon McVie, the director-general, said: "This is preliminary work and highly speculative. It is early days but we are excited by the potential."

The researchers, led by Dr Siow Ming Lee from University College, London, hope to harness the same property that caused birth defects, by limiting blood flow to developing limbs, to attack the cancer by starving the tumour of the oxygen it needs to grow.
Thalidomide is thought to inhibit the growth of blood vessels that feed tumours and maystabilise the blood flow.

26 Jan 01 - Medicine - Doctors attack research on MMR

by Zoe Morris, Health Reporter

Evening Standard - Friday 26 January 2001

The controversy over the combined measles, mumps and rubella jab continued today, as two London doctors attacked a third's research which linked the vaccine with autism and bowel disease.

The latest twist in the saga over the triple vaccine, which has left parents confused over what is the safest way to protect their children, adds weight to the Government line that MMR is safe.

Dr David Elliman, of St George's, and Dr Helen Bedford, of Great Ormond Street Hospital, today publish an editorial in the British Medical Journal in which Dr Andrew Wakefield is accused of publishing "incomplete" research and not taking an "impartial" approach to the debate.

Dr Wakefield, a gastroenterologist at the Royal Free Hospital, claims to have identified a distinct syndrome among children affected by MMR - featuring autism and bowel disease. He also raised doubts about trials of the vaccine in the Seventies, suggesting they were not long enough and that some of the children involved experienced side-effects.

However, the BMJ article states: "We have reviewed the latest developments in this saga and are convinced that such confusion and anxiety about MMR vaccine are unfounded."

It adds: "However weak the scientific evidence

which triggers vaccine safety scares, they provoke anxiety among parents and health professionals which can lead to a decline in vaccine uptake."

In some parts of London the uptake of MMR has fallen to less than 75 per cent - sparking fears of reemergence of measles, which claimed the lives of two children in Dublin last summer.

The doctors say Dr Wakefield's latest research added "nothing new" and other studies of the vaccine over the past 30 years have proved it to be safe.

Dr Bedford told the Standard parents need to be reassured about the vaccine. "I keep imagining I'm a parent waking up on the morning when my child is supposed to have their MMR and there are all these stories in the papers and safety fears," she said. "It is not appropriate that people are making decisions based on what they read in the newspaper."

Dr Wakefield was not available for comment. The Government has launched a £3million campaign aimed at convincing parents the triple vaccine is safe, but 2,000 families are preparing legal cases, claiming children developed autism after the jab.

Meanwhile, Sarah Dean, director of the Direct Health 2000 clinic which has been giving children separate doses of the vaccines, has renewed calls for the Government to lift restrictions on importing the unlicensed vaccines. Currently, the Medicines Control Agency has to be notified about any imports and shipments are limited to 25 doses at a time.

Scientists think victims of Down's syndrome may hold a vital new weapon against lung cancer in their genes .

Researchers found that people with the genetic disorder, which affects about one in 600 newborn babies, have an extra copy of a gene that appears to protect against lung cancer .

In most people genes come in pairs, but Down's sufferers have three copies of the newly identified gene, called USP25. The same gene is often missing from the tumour cells of people with lung cancer.

Scientists believe the discovery may help them develop new drugs or gene therapies that can fight or prevent the disease, which affects about 40,000 people a year in the UK.

A team from the Cancer Research Campaign charity made the connection after noticing that people with Down's syndrome were much less likely than the rest of the population to develop common cancers, including lung cancer.

Down's sufferers are less than half as likely than the rest of the population to develop many solid tissue cancers. But they are 10 to 20 times more likely to develop childhood leukaemia.

Dr Dean Nizetic, from the University of London's Centre for Applied Molecular Biology, who led the research, said: "This gene could be an important part of the body's complex protective mechanism that stops people from developing lung cancer.

"People with Down's syndrome are resistant to many forms of cancer. Thanks to this, we may now find new ways of preventing these types of the disease, including lung cancer, potentially saving many lives. Progress will also be a tribute to the scientists who decoded the genetic information responsible for Down's syndrome."

The scientists now hope to find out for certain whether USP25 protects against lung cancer and exactly how it works.

23 Jan 01 - Medicine - Peers back cloned stem cell research

Controversial new research on human embryos was given the go-ahead last night after peers backed government legislation to allow testing on cloned stem cells.

Scientists and government supporters defeated an attempt by religious leaders and pro-life campaigners to delay the research for several years by 212 votes to 92.

An amendment paving the way for a select committee inquiry to monitor the initial stages of the new research was agreed by peers unopposed. The parliamentary order, which extends scientific research using cloned embryos that can at the moment be used only for fertility treatment, comes into effect at the end of the month.

The Government's opponents, led by Lord Alton of Liverpool, had argued that a select committee should study the issues in greater detail before the order was given parliamentary approval. That would have wrecked the Government's proposed change, forcing ministers to return to the issue afresh in the next Parliament.

The decision came at the end of an impassioned debate in which opponents of so-called "therapeutic cloning" of human embryos argued the move ignored the sanctity of life. Lord Alton said it would allow human embryos to be treated as "just another accessory to be created, bartered, frozen or destroyed".

Other critics included the Archbishop of Canterbury, the Roman Catholic archbishops of Glasgow and Westminster, the Chief Rabbi and the President of the Muslim College.

But supporters, including the eminent neurosurgeon Lord Walton of Detchant, said that there were people suffering from a range of illnesses who did not have time to wait.

Lord Hunt, the Health Minister, said that embryo research could prove critical those suffering from Parkinson's disease, cancers, strokes, heart disease and other serious conditions. The science was clear that stem cell research had the potential to provide the answers to many debilitating illnesses.

He said: "The human embryo has a special status and we owe a measure of respect to the embryo. We also owe a measure of respect to the millions of people living with these devastating illnesses and the millions who have yet to show signs of them."

23 Jan 01 - Medicine - Down's gene may help cancer fight

People with Down's syndrome hold the key to finding a gene that may help to protect against lung cancer, scientists believe.

Research has shown sufferers with the syndrome have three copies of the gene, which is one more than the rest of the population. The gene, USP25, is often missing from cancer cells of people who develop lung cancer. The researchers believe that the loss of the gene could play an important part in developing the disease.

A team run by Dr Dean Nizetic at the School of Pharmacy, London University, has been working with Dr Denise Sheer of the Imperial Cancer Research Fund. Dr Nizetic said: "This gene may be an important part of the body's protective mechanism that stops people from developing lung cancer. When cells lose their protective genes, that's when they are likely to turn cancerous. People with Down's syndrome are resistant to many cancers. Thanks to this we may find ways of preventing these types of the disease."

The gene is similar to others which are known to have protective effects against cancer. Prof Gordon McVie, director-general of the Cancer Research Campaign, said: "The work is vital because if we know how people with Down's syndrome are better protected from cancer then perhaps we can protect the rest of us as well."

Carol Boys, of the Down's Syndrome Association, welcomed any further research especially if it helped to understand why people with the syndrome were more likely to have other health problems.

22 Jan 01 - Medicine - Experts try to ease fears over MMR jab

Medical experts will hold a summit meeting today to draw up a strategy aimed at reassuring the public about the safety of the measles, mumps and rubella (MMR) vaccine.

The move follows yesterday's publication of research that raises doubts about the vaccine's safety. A Department of Health spokesman said: "The purpose of the summit is to reassure the public about the safety of the vaccine and explain why it is much better than the alternative of having single vaccines. We all agree about this. The only person who doesn't is this man Dr Andrew Wakefield."

Dr Wakefield, a consultant gastroenterologist at the Royal Free Hospital in London, criticised trials of the jab in an article in the medical journal Adverse Drug Reactions. He claims the trials were too small and did not follow children up for a long enough period to gauge problems.

Dr Wakefield's report said there was evidence more than 20 years ago that combining three live viruses in one jab could be dangerous. His study concluded that there were indications that the triple jab was linked to autism and inflammatory bowel disease.

But the Department of Health and the Medicines Control Agency accused researchers of scaremongering and "totally rejected" that MMR vaccines were licensed prematurely. The British Medical Association insisted that the vaccine was safe, although Dr Dr Wakefield's research links it to nearly 170 cases of autism and bowel disease.

In parts of the country the vaccination rates have dropped from 92 per cent to 75 per cent, a level that experts say could lead to a fatal measles epidemic. About 500 parents are taking action against the Government, claiming their children developed Crohn's disease after receiving the jab.

The government wheeled out the heavy guns of the medical establishment yesterday to counter the growing crisis of confidence in the MMR vaccination programme, which threatens a measles epidemic.

Liam Donaldson, the chief medical officer, drew on the support of several medical organisations to declare MMR safe and effective and to reject calls for it to be separated into three single vaccines.

Reflecting the Government's frustration at the growing controversy over the MMR vaccine's supposed risks, Professor Donaldson announced a £3m publicity campaign, to be launched on Thursday, to bolster public confidence.

Many parents have been alarmed at reports of its alleged links with bowel disease and autism, and private clinics offering the single vaccines have been overwhelmed. National vaccination rates have fallen from 93 per cent to 88 per cent - and in some areas as low as 74 per cent - raising the risk of an outbreak of the diseases.

More than 1.5 million leaflets and 40,000 posters will be distributed, backed by a four-week television advertising campaign in February. A video will be provided for parents at GPs' surgeries and information packs will be sent to health workers.

At a conference on the crisis called by the Health Department yesterday, medical organisations including the Royal Colleges of Paediatrics, GPs and Nurses threw their support for the campaign behind the chief medical officer.

Professor Donaldson said: "Every single one agrees the vaccine is the safest and best way to protect children against measles, mumps and rubella. MMR is used successfully in over 30 countries. On each occasion these health scares are raised, MMR has been given a clean bill of health."

The latest flurry of alarm was triggered by new claims by Dr Andrew Wakefield, of the Royal Free Hospital, London, that it was not properly tested before its introduction in Britain more than 20 years ago.

Dr Wakefield, a specialist in gastro-enterology, triggered the original scare about the vaccine with research papers in 1995 and 1998 suggesting it could be linked with bowel disease and autism. Although he has become more of a lone voice, his warnings have chimed with some parents of autistic children convinced the vaccine caused the mental and physical deterioration.

That concern caused vaccination rates to fall from their peak but nine out of 10 parents still have their children vaccinated with MMR and there were signs the rate was rising again before the latest scare.

Professor Donaldson, with representatives from the Public Health Laboratory Service, the Medicines Control Agency and the British Medical Association, said there was no new evidence in Dr Wakefield's latest report, published in the Journal of Adverse Drug Reactions, to change the view that the vaccine was safe.

Asked why he would not let parents choose single vaccines, he said it would mean abandoning a very effective, safe vaccine that had virtually eliminated the diseases for a strategy which, because of the spacing of separate vaccines, may allow outbreaks of measles, mumps or rubella. Japan, the only country to recommend single vaccines, has had repeated outbreaks of measles with 79 deaths since 1992, compared with none in the UK.

"The evidence is if you introduce single vaccines you place children at risk and I don't want to be responsible as chief medical officer for the deaths of children," Professor Donaldson said.

22 Jan 01 - Medicine - New claims of vaccine danger rebutted

New salvoes were fired yesterday in the war between a scientist who believes there is a link between the MMR vaccination and autism and the medical establishment, which has consistently rebutted the hypothesis.

Andrew Wakefield, a consultant gastroenterologist at the Royal Free hospital in London, is now alleging that the combined measles, mumps and rubella vaccination was not tested thoroughly enough for safety before it was introduced in Britain in 1988. In a paper shortly to be published in the medical journal Adverse Drug Reactions, he claims that children given the combined jab were not followed up for long enough to be sure that there were no side-effects.

The renewed battle over the MMR will dismay public health officials, who have warned that there is the danger of a potentially fatal measles outbreak if parents do not take their children for vaccination. Only 88% of children are now being vaccinated because of public uncertainty. In Ireland and the Netherlands, low vaccination coverage last year led to deaths from measles. The World Health Organisation says 95% coverage is advisable to prevent an outbreak.

Yesterday the Department of Health produced a long and detailed rebuttal of Mr Wakefield's latest allegations, based on reviews of his work carried out by independent scientists on the joint committee on vaccination and immunisation and the committee on the safety of medicines.

The paper by Mr Wakefield claims that children given the MMR jab in the pre-licensing trials were not followed up for longer than 28 days and therefore long-term side effects of the vaccinations would not have been picked up.

The Department of Health said yesterday that this was "factually incorrect". Most of the trials followed children for four to six weeks, one particular trial monitored them for six to nine weeks and a minority of children in the trials were followed up for a year. The department accused Mr Wakefield of biased reporting. "Studies that fail to support the author's views are not mentioned," it said.

Mr Wakefield's thesis, which caused a furore when published in the Lancet in 1998, is that the MMR jab can trigger Crohn's disease, a bowel disease, in certain susceptible children, which in turn can lead to autism. He claims in the new paper that some small trials in the US showed that significant numbers of chil dren developed stomach bugs, but that in spite of this, the follow-up period was reduced to 21 days from 28 days.

His original work was on just 12 children whose parents said they showed no signs of autism until after their MMR jab. Mr Wakefield's opponents point out that the vaccination takes place at around 18 months, the same time that autism is usually noticed. A study of all the autistic children in part of north London was commis sioned by the Department of Health, which concluded that there was the same rate of autism in children who had been vaccinated with the MMR and those who had not.

Mr Wakefield and colleagues claimed to have found signs of the measles virus in the gut of autistic children. But nobody has been able to replicate this finding. A panel of top scientists, convened by the medical research council at the request of the Department of Health, reviewed Mr Wakefield's data and found no evidence to substantiate his claim of the link between MMR and either bowel disease or autism.

But many parents of autistic children, searching to understand and explain what has happened to them, are convinced the MMR vaccination must be to blame. Mr Wakefield said yesterday that he now has 170 children on his books, instead of the original 12, and that in most cases the parents could show the autism appeared after the MMR.

Professor Brian Duerden, medical director of the public health laboratory service, said yesterday that he could find "no hard scientific basis at all" for Mr Wakefield's claims. "He is a fervent believer in his views on this," said Prof Duerden. "One person's idiosyncrasy and interpretation puts the vaccination programme and the need to protect children at risk."

22 Jan 01 - Medicine - £3m campaign against the MMR doubters

The Government is beginning a £3 million publicity campaign to reassure parents about the safety of the MMR vaccine.

Desperate to reverse the decline in the take-up of the vaccine after fears of a link to autism were raised, the Department of Health yesterday organised a "summit" at which leading organisations declared their support for the vaccine, and agreed a joint statement.

The statement rejects claims by Dr Andrew Wakefield, of the Royal Free Hospital, North London, that MMR was introduced before its safety was assured.

Dr Wakefield's reading of the scientific literature is "highly selective" and does not present an accurate picture, the department said. His suggestion that the three vaccines - for measles, mumps, and rubella - should be given separately rather than together raises "real concern" because it would expose children unnecessarily to these potentially serious diseases.

The fear is that if the MMR vaccination rate falls, children will again catch measles, and some will die. In some parts of the country only 75 per cent of children are immunised, far below the World Health Organisation's recommendations that at least 90 per cent must be vaccinated in order to protect the whole population.

Professor Liam Donaldson, the Chief Medical Officer, said after the meeting that the publicity campaign would begin on Thursday with newspaper advertising aimed at the public and professionals.

A month-long television advertising push aimed at mothers of young children will go ahead next month, and information packs will be sent to 30,000 GPs, health visitors and nurses, to persuade them that the jab is safe for children.Professor Donaldson denied that the Government was losing the PR battle over MMR. There was, he said, "a very solid base of parents" - overall, nearly nine out of ten - who had confidence in the vaccine.

"There is a lot of certainty about the safety of the vaccine" he said. "It has been around for decades, millions of children have been vaccinated. It is wrong to focus on a small number of people's claims, against the views of a large number of people who have failed to replicate the results and who are prepared to back MMR.

"We have had discussions today with all of the major health organisations in this country about the MMR vaccination programme.

"Every single one of them agrees that the MMR vaccine is the safest and best way to protect children against measles, mumps and rubella.

"Whenever there is a health scare, parents are left confused. They should be left in no doubt after today's summit that the advice from doctors, nurses and every major health organisation is that they should have their child vaccinated with MMR."

The MMR vaccine is used in the US, Canada, and more than 30 European countries. Dr Liz Miller of the Public Health Laboratory Service told the summit that since 1990, just over a year after introduction of MMR in Britain, there have been no measles deaths, and no cases of meningitis caused by mumps.

A condition related to measles, called SSPE (sub-acute sclerosing pan-encephalitis), whose symptoms are similar to those of CJD, had also disappeared.

By contrast in Japan, where the single measles and rubella vaccines are used, there are still many cases of measles and between 1992 and 1997, 79 children died from the disease.